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I FOR OFFICE USE. APPLICATION ftifiANITATION PERMR hrmit No. .� 1� . ..... ..... / (Complete in Duplicate) Date Issued -- . .... ... This Permit Expires T Year From Date Istued Application is hereby made to the San Joaquin Local Health District far a permit 10 construct and Instal the work herein deaoi6ed. i This application is made in compliance with County Ordinance No. 549. JOB ADDRESS D LOCATI N..�_ /- ��, Q.., a{.,I1L4..r .. GC.f. .. ./.t.7G. I A.rt.•...... C�!/f( Owner's Name Q�RL: .J�' /t-d4-7t.._...._..........__............. _ . _..__ _ _..._�_�f/ G!. ContractorsName....._ _ ....................... .. ..................................... ................. . .... Phone................... Installation WIN serve: Reside (,Ape rh isnf House ❑ Commercial ❑ Trailtr Court ❑ Motel Other Q Number of living units: ..... Number of bedrooms.wf... Number of bafhsa?.:ylet she , ,....,. 49. •••_.......... Water Supply: Public system ❑ Community system Q Private IR Depth to Wafer Table"S . ff. Character of ail to a depth of 3 fad: Send❑ Gravel❑ Sandy Loam❑ Clay Lam❑ Clay Q Adobe ly Hardpan Q Prwieus Application Made: (if yes,date..... .. ._ .. ) No Id New Construction: Yes,6 No Q FNANAc Yat❑ Ne 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tankercesspool permitted if puubte www is avaRable within 200 fed.) Septic Tank: Distance from nearest well.... O......Distancjs yfrom foundation �..0..,. McMial..f..-fl")LFr.:R�(A:L.C..•---_ No. of compartments....... ...............x 11, 5i:e..7 �lZ..x.:7_liquid depth-aS ...... Capadty_,13.G.tn_ Disposal Field: Distance from nee well...q..Q....Distance from famdafion,.y7�! 0,144rice to ""No bt IM� ---- Number of lines.._.....��••.....��...//��L�ength of each fine�i.0•. .00��O.-�idli of freneh..,�,/ ._......_._..._ Tips of fiber [.7-CSCDerth of filter material.../.y... ... ...Total length......._...... Seepage Pit: Distance to nearest well......................Distance from foundation................. Distance to nearest let Iia.__._.._.,. 0 Number of pih......................Lining material.......... ..... __Sisr. Diameter............... .....Depth...............---------- Cesspool: Distance from nearest well................Distance from foundation _ .-... -Lining material............... ..... _. ❑ Sim: Diameter.....................................Depth......................___. .. .......Liquid Capacity...... _qeh Privy: Distance from nearest well...............i......................... _-.Distance from nearest Wilding......._........—... ------------- ODistance to nearest lot lire1..............,...._............_...... . ..____..........._ ............_..........__..............._..._.................. Remodeling end/or repairing (deteribe):.�..!/s-s.�.S%(.'s1e.C.6•....._..L.l. ...._[..C. ......:L.........:..L^:...�:..-....r3._.x....._.vG:..� I ��/I ' 1.,t...!' ...... . .. -_„...._......._........_.......-....».................I4 ... fa:3•.L.f.::.G.6.a_..�.lt.... . ..........._..._.................................. ... ....... .. .........._._._.._.rs•-.7e�Jl.:-.(i►..�--....... :�r 1.. yC............ e", .. .:�-.._.._............._.._._......._. in 1 :;n tW I have prepared this application and that Ow work wM be done accordance with San Joequ ord:.,aencm 5tde Iws. old rules and regulation of the San Joaquin Local HOOK Dhfrief. Si mad / _....(Owner and/or Co. (ntle�........ (Plot plan.showing sin of lot, lecafiee of systam in mlafion to we%, butidings, ate.. can M placed on reverse sldej. FOR DEPARTMENT USE ONLY -- .... DATE. ._............. . ... .. . ... .... APPLICATION ACCEPTED 8Y - .-.. � � � � � -- _ .... DATE_ .j.2'.,_5..... .........._........... REVIEWED BY..................._....... . BUILDING PERMIT ISSUED..._.................... . . ....... _ ..... .. DATE.............. .._............Sa...T-��...._ Aherdfoes and/or recommendation:_ _. ._.........._ _.. ......... ...... ..........................__..........._......._...._........... - _. . . _._._.. ._.. . ..............................................._................. ........................................ ...-_................ .. .............................................._.........._........_._ ........_...............................____.. .. __.. . . ......................................................._.........._... ....................................... . . . .. . .. .. ........ .. .................................................... ................................. ... FINAL INSPECTION BY. Ci C4�r Dnre IIZ..'. �.�..�..�.r_. .. ............__..._........ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Si,.*l..W ..Sr.... sere W...W.3....• r r.tr......n Sr.... see WMr as praw 1Ndwe.Cdif.mw lM�,hnb.wi. ...•ren.C.n1..ni. irNNr Ca1tlIrIM 1.9 9 aEv.sto .-0. rte a-.a .fills ""�